范例,许左隽,陈启稚,卓杨,王长谦

• 1:上海交通大学医学院附属第九人民医院心内科

摘要(Abstract)：

目的探讨冠状动脉病变特征与支架置入术后斑块脱垂的关系。方法回顾性分析2017年1月至2019年5月于上海交通大学医学院附属第九人民医院心内科住院诊断为急性冠状动脉综合征的33例患者,均行冠状动脉造影和支架置入术,术中行光学相干断层成像(OCT)检查,收集支架置入术前及术后OCT的斑块成像指标。结果根据有无斑块脱垂分为斑块脱垂组(22例)和无斑块脱垂组(11例),两组患者基线资料比较,差异均无统计学意义(均P>0.05)。斑块脱垂组患者C反应蛋白[(4.93±3.42)mg/L比(1.36±0.25)mg/L,P<0.001]、肌红蛋白[(245.11±349.05)ng/ml比(55.35±51.97)ng/ml,P=0.020]、白细胞计数[(8.59±2.41)×10~9/L比(5.90±1.52)×10~9/L,P=0.002]均大于无斑块脱垂组,差异均有统计学意义。斑块脱垂组平均脂质弧[(277.80±63.40)°比(227.73±29.61)°,P=0.004]与白色血栓(12/22比0.0,P=0.002)、红/混合血栓(10/22比0.0,P=0.007)、夹层(12/22比1/11,P=0.013)及薄帽纤维粥样斑块(TCFA)(18/22比1/11, P<0.001)比例均大于无斑块脱垂组,差异均有统计学意义。Kendall tau-b相关系数分析显示,斑块脱垂与TCFA(r=0.694,P<0.001)、纤维帽厚度(r=0.543,P<0.001)、脂质弧度(r=0.304,P=0.028)、夹层(r=0.439,P=0.009)、白色血栓(r=0.533,P<0.001)、红色血栓(r=0.466,P<0.001)均有相关性。斑块脱垂组最小管腔面积明显小于无斑块脱垂组[(5.73±1.67)mm~2比(8.06±2.50)mm~2,P=0.003],但合并血栓脱垂比例(9/22比0.0,P=0.013)显著高于无斑块脱垂组,差异均有统计学意义。结论斑块脱垂与冠状动脉脂质斑块包括脂质弧、夹层、合并血栓等特征密切有关;并提示术后获得的管腔面积也更小。

关键词(KeyWords)： 光学相干断层成像;斑块脱垂;急性冠状动脉综合征;薄帽纤维粥样斑块

Abstract:

Keywords:

基金项目(Foundation): 上海市科学委员会基金项目（18411950500）

作者(Author): 范例,许左隽,陈启稚,卓杨,王长谦

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